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What keeps a bipolar patient well long-term?
More, if you want it
What does the patient ask about the tablets after mania?Tap a term: its definition, what you can do with it, and how often the exam asks it.
Definition: keeping the antimanic drug for 3 to 6 months after mania settles, then a review.
You can: Tell continuation treatment from long-term maintenance treatment by how long the patient stays on the drug.
Definition: treatment for at least 2 years, and up to 5 years when relapse risk is high.
You can: Tell long-term maintenance treatment from continuation treatment by the 2-year minimum and the 5-year limit.
Definition: the mood stabiliser shown to reduce suicide in bipolar disorder.
You can: Tell lithium from valproate by the lower suicide risk with lithium.
Definition: a drug that gives no protection as maintenance treatment.
You can: Tell a tricyclic antidepressant alone from a mood stabiliser by whether the drug prevents a new episode.
Definition: the drug used instead of lithium, started low and raised slowly.
You can: Name valproate in renal impairment when a patient has poor kidney function or a kidney transplant.
Definition: lowering a mood stabiliser dose over at least several weeks to months.
You can: Tell gradual withdrawal from abrupt stopping by how fast the dose falls.
Each card is one term. The grey line is what the patient says, which is what the question stem gives.
Summary
Continuation treatment is keeping the antimanic drug for a further 3 to 6 months after mania resolves. An antimanic drug is a drug that treats an acute manic episode. The person chooses continuation treatment instead of starting long-term treatment. A review follows at the end of the 3 to 6 months.
In the UK, antipsychotics are the usual first drugs for acute mania. Mood stabilisers are kept mainly for longer-term prevention. Residual mood symptoms after an episode strongly predict recurrence. The review looks for these symptoms. Compared with continuation treatment, long-term maintenance treatment lasts years.
Grace sees her consultant in an outpatient clinic after her mania settles. Grace says, "I want to stay on my mania tablet a few more months, then decide."
Continuation treatment runs for 3 to 6 months, then a review decides what comes next.
7 more sections on Bipolar maintenance treatment: lithium, valproate, duration, withdrawal and more
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